2-Arachidonoylglycerol Activity in Over Ischemia Reperfusion Damage: Can Endocannabinoids Protect Ovarian Reserve?

Objective: The present study aimed to demonstrate the possible effects of increased 2-arachidonoylglycerol (2-AG) by applying the monoacylglycerol lipase inhibitor KML-29 on rats with ovarian ischemia-reperfusion (IR) model. Methods: Forty-eight female Wistar albino rats were divided into six groups. Group 1: Sham, Group 2: Ischemia, Group 3: IR, Group 4: IR + KML-29 (2 mg/kg), Group 5: IR + KML-29 (20 mg/kg), and Group 6: IR + vehicle (dimethyl sulfoxide). Three hours of ischemia followed by 3 h of reperfusion. Two different doses of KML-29 (2 and 10 mg/kg) were administered intraperitoneally in Groups 4 and 5, 30 min before reperfusion. Ovarian IR injury and ovarian reserve were evaluated histopathological and by using nuclear factor (NF)-κB, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-β1, superoxide dismutase, glutathione peroxidase pre-/postoperative blood antimullerian hormone, and inhibin B. Results: In the KML-1 and KML-2 groups, this damage was significantly reduced compared to the ischemia group. NF-κB, IL-1β, TNF-α, and TGF-β1 immunoreactivities increased statistically significantly in the ischemia group compared to the control group (p<0.001). Immunoreactivities of these proteins were significantly decreased in the KML-1 and KML-2 groups (p<0.001). It was observed that the number of these apoptotic cells decreased significantly in the KML-1 and KML-2 groups compared to the ischemia group (p<0.001). The postoperative inhibin level showed a significant decrease in the ischemia group compared to the sham group, while a significant increase was observed in the KML-1 and KML-2 groups compared to the ischemia group. Conclusion: It was seen that anti-inflammatory, antioxidant, and antiapoptotic activity was formed, and the ovarian reserve was preserved with 2-AG in ovarian IR damage. The protective effect of endocannabinoids on the ovaries may create a promising new treatment strategy for many pathologies that will affect the ovarian reserve.

Placental and Umbilical Cord Blood Oxidative Stress Level and Telomere Homeostasis in Early Onset Severe Preeclampsia

OBJECTIVE

Although the etiopathogenesis of preeclampsia (PE) is unknown, evidence suggests that it may be associated with increased oxidative stress. Studies have shown that oxidative stress can affect DNA fragments called telomeres. However, the interactions of PE, oxidative stress, and telomere length are not clearly known. This study aims to evaluate the oxidative/anti-oxidative stress balance in the placenta and umbilical cord and examine the effect of oxidative stress on telomeres.

MATERIALS-METHOD

Cord blood and placental samples were collected from 27 pregnant women with severe PE (28^0/7-33^6/7 gestational weeks) and 53 healthy pregnant women. Telomere length (TL) was measured by real-time PCR in the cord blood and placenta tissue. Total antioxidant status (TAS) and total oxidant status (TOS) levels were measured in the cord blood and placenta tissue using a colorimetric method.

RESULTS

No significant differences were found between groups regarding age, BMI, gravida, parity, and newborn gender (p>0.05). Cord blood and placental TL of PE patients were significantly shorter than the control group, while cord blood and placental TAS and TOS levels were higher (p<0.05). The results of a multivariate logistic regression analysis showed that the level of placental TOS in PE patients (OR=1.212, 95% CI=1.068-1.375) was an independent risk factor affecting PE.

CONCLUSION

This study found that oxidative stress is an independent risk factor in the development of PE and shortens TL in both placental and umbilical cord blood. Future research on telomere homeostasis may offer a new perspective for the treatment of PE.

Bernard-Soulier Syndrome from the Perspective of the Obstetrician: A Case Report with a Review of the Literature

OBJECTIVE

Bernard-Soulier syndrome (BSS) is one of the rare inherited platelet disorders that is characterized by macrothrombocytopenia and adhesion abnormality due to the absence or malfunctioning of the membrane GPIb-IX-V complex. There is no high-quality evidence on obstetric management of BSS owing to its rarity. Here we report an uncomplicated delivery of an adolescent with BSS and review the literature on the topic of BSS and pregnancy.

METHODS

PUBMED, EMBASE, COCHRANE, and Google Scholar databases were searched up to April 2022 without language and year restriction using the terms "Bernard Soulier" and "Pregnancy". The primary objectives were to evaluate maternal and fetal outcomes. The secondary objectives were to analyze pregnancy complications, gestational age at delivery, mode of delivery, administered prophylaxis, treatment approaches, duration of postpartum hospitalization, and the postpartum requirement of blood and blood product.

RESULTS

The patient was a 19-year-old and 39-week pregnant woman who was diagnosed with BSS at the age of 10 by flow cytometry and genetic analysis. Single donor platelet transfusions and oral tranexamic acid were administered as prophylaxis at the peripartum period. She was delivered by cesarean section due to failure of labor. The postpartum period was uneventful for both mother and neonate. In the literature review, postpartum hemorrhage (PPH) was found in 52.9% (27/51) of deliveries. Late PPH occurred more frequently than early PPH (35.3 and 31.4%, respectively). 49% (25/51) of pregnancies had severe thrombocytopenia, and antepartum hemorrhage was observed in 11.8% (6/51) of those. The platelet count was in close relation to antenatal complications. 64.7% (33/51) of the patients were delivered via cesarean section. PPH and late PPH were found to be more common in those who delivered vaginally compared to those who delivered by caesarean section. It was observed that PPH was less common in women who were given prophylaxis in the peripartum period.

CONCLUSION

BSS is an inherited macro-thrombocytopathy that may cause adverse maternal and neonatal outcomes. The optimal mode and timing of delivery remain unclear. A multidisciplinary approach with prophylaxis at the peripartum period should be applied.

Serum levels of mu-opioid receptor according to menstrual cycle phases are associated with postoperative pain and opioid consumption in laparoscopic gynecological surgeries: a prospective observational study

AIMS

In this prospective observational clinical study, we aimed to evaluate the relationship between serum mu-opioid receptor (MOR) levels according to menstrual cycle phases on postoperative pain scores and analgesic requirements.

METHODS

A total of 80 female patients undergoing laparoscopic surgery were divided into two groups according to the phases of the menstrual cycle as follicular and luteal. Postoperative pain scores, total tramadol consumptions, and numbers of demands on patient-controlled analgesia (PCA) of the patients were recorded at 5 time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour in the ward, T3: 12th hour in the ward, T4: 24th hour in the ward). Serum MOR concentrations were measured by enzyme-linked immunosorbent assay.

RESULTS

The mean serum MOR levels were significantly higher in the follicular group (275 ± 32 pg/ml) compared to the luteal group (254 ± 28 pg/ml) (p = 0.003). Total tramadol consumption (T0, T2, and T3) was significantly higher in the luteal group (p = 0.031, p = 0.012, p = 0.017, respectively). Postoperative pain scores did not differ significantly between the groups. With the exception of T4 (p = 0.057), the number of demands on PCA was significantly higher in the luteal group. However, multivariate logistic regression analysis showed that serum MOR levels were affected by the menstrual cycle phase (follicular) (β = 0.361) (p = 0.001).

CONCLUSIONS

Our study revealed that patients during the follicular phase with higher serum MOR levels consumed less opioid analgesic postoperatively. More comprehensive studies are needed to determine the relationship between serum MOR levels and menstrual cycle phases as well as postoperative pain. (Trial registration number: NCT04690491 www.

CLINICALTRIALS

gov ).

Brucellosis in pregnancy and its response to the changing immunoglobulin A: A prospective controlled study

Objective:

This study aimed to define the rare Brucella infection in pregnancy and its effects on immunoglobulins (Ig).

Materials and Methods:

This prospective study has conducted Brucella screening using the Rose Bengal test on pregnant and non-pregnant outpatients who did not show any specific Brucella symptoms. The immunoglobulin levels were measured using the enzyme-linked immunosorbent assay. The study group consisted of pregnant women who were at 20 weeks or below gestation and applied to our hospital outpatient clinic for routine check-ups. The control group consisted of healthy patients who applied for routine controls.

Results:

This study included a total of 584 participants, 293 of whom were controls and 291 were the study (pregnant) participants. The study revealed a 1.5% incidence of Brucella during pregnancy. In acute and chronic Brucella infection, lower levels of IgA response were observed in pregnant cases compared to the control group.

Conclusion:

Brucella infection is a disease that can cause fetal problems, especially in endemic areas. The role of the altered IgA response in pathologies that are associated with Brucella infection stands out as a new target for disease pathophysiology.

Can pycnogenol prevent cisplatin-induced damage in uterus and ovaries?

INTRODUCTION

Cisplatin is an antineoplastic agent, which is thought to act on tissues with increased levels of reactive oxygen species and decreased levels of antioxidants. Pycnogenol is a potent antioxidant that is used in medical conditions caused by oxidative stress. The aim of our study is to demonstrate the effects of pycnogenol on cisplatin-induced uterine and ovarian damage in rats.

MATERIAL AND METHODS

Wistar albino female rats were randomly divided into 3 groups before the experiment as follows: a 2.5 mg/kg cisplatin group (CG; n = 10), a 40 mg/kg pycnogenol + 2.5 mg/kg cisplatin group (PCG; n = 10), and a healthy control group (HG; n = 10). Then, the ovaries and uteri of the rats were examined to determine malondialdehyde (MDA), total glutathione (tGSH) and superoxide dismutase (SOD) biochemical levels and the histopathological findings.

RESULTS

Our study demonstrated that, in uterine and ovarian tissues of rats administered with cisplatin, there was a decrease in the levels of tGSH and SOD, while MDA was increased; however, it was observed that these ratios were reversed in the PCG group (p < 0.05). The number of follicles in the ovarian tissues was examined in all 3 groups. When the CG group was compared with the other two groups, the number of primordial, developing and atretic follicles was low, but there was no difference in the corpus luteum count.

CONCLUSIONS

Pycnogenol pretreatment alleviates cisplatin-induced uterine and ovarian injury in rats because of its antioxidative effect.

Increased serum myonectin and irisin levels with myonectin and FNDC5 expressions in polycystic ovary syndrome: a case control study

The aim of this study is to assess the FNDC5 and myonectin expressions and serum levels of myonectin and irisin in women with PCOS. 90 participants were included in this case-control study. 45 of these participants were with PCOS, and 45 of them were healthy volunteers matched for age and body mass index (BMI). Serum irisin and myonectin levels were measured with commercially available enzyme-linked immune sorbent assay (ELISA) kits. Expression of the myonectin and FNDC5 genes were determined by RT-PCR analysis. It was found out that FSI, HOMA-IR, LH, LH/FSH, TT, serum irisin and serum myonectin levels, myonectin mRNA expression, and FNDC5 mRNA expression were higher in the PCOS group, whereas HDL-C level was lower in the PCOS group (p < .05). When the groups were compared, it was detected that IR and HA were significantly higher in the PCOS group (p < .05). Serum irisin and myonectin levels, and myonectin and FNDC5 mRNA expressions were increased in women with PCOS. These molecules can be target molecules in PCOS pathophysiology and treatment.IMPACT STATEMENTWhat is already known on this subject? Although the aetiology of PCOS is not fully understood, it is thought that insulin resistance may play a critical role. In recent studies, the relationship of cytokines secreted from skeletal muscle with insulin resistance has been shown. The effects of irisin and myonectin, which are members of the myokine family, on lipid and glucose metabolism are known.What do the results of this study add? Although there are many studies in the literature regarding serum irisin levels in women with PCOS, their results are confusing. There is a study in the literature investigating the relationship between myonectin and PCOS. In our study, we evaluated myonectin and FNDC mRNA expressions in addition to serum irisin and myonectin levels. As a result, we found that markers and their mRNA expressions were lower in patients with PCOS compared to controls.What are the implications of these findings for clinical practice and/or further research? We think that the results of our study will shed light on future studies. Due to their effects on adipose tissue, these markers may play a role in the aetiology of long-term complications of PCOS. Moreover, they can become pharmacological targets in preventing these complications.

The Effect of Preoperative Anxiety on Fetal Cord Blood Tumor Necrosis Factor-Alpha, Interleukin-6, and Neonatal Outcomes in Pregnant Women

BACKGROUNDS

In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-α, IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood.

SUBJECTS AND METHODS

Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-α, IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1^st and 5^th minutes after birth were recorded.

RESULTS

The mean preoperative maternal SAI and TAI scores were 46.6±10.9 and 41.4±7.8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-α, IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values.

CONCLUSIONS

Our results show that an increase in the levels of TNF-α, IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn.

The effect of placental angiogenic and anti-angiogenic factors on pregnancy outcome in patients with early onset preeclampsia

Objective:

The aim was to evaluate the possible effects of anti-angiogenic factors including soluble endoglin (sEng), placental growth factor (Pgf), and soluble fms-like tyrosine kinase 1 (sFlt-1) in both normotensive pregnant patients and preeclampsia (PE) patients.

Material and Methods:

The study was carried out at the Departments of Gynecology and Obstetrics and Biochemistry of Yozgat Bozok University Training and Research Hospital. Eighteen women with PE who were pregnant for at least 20 weeks comprised the study group. The control group consisted of 33 pregnant women with no complications and with similar demographic features. In the study, laboratory parameters, demographic characteristics, sEng, sFlt-1, and Pgf levels, delivery type, APGAR scores of the infants, and birthweight were determined and a comparison was made between the groups.

Results:

It was found that the sEng level was significantly lower in the PE group compared to the control group (p<0.05). In addition, the Pgf, birthweight, and 1^st and 5^th-minute APGAR scores were significantly lower in the PE group compared to the control group (p<0.05).

Conclusion:

The decrease in Pgf may have an effect on the pathogenesis of PE and can be utilized for the determination of PE.

Behaviors and Attitudes of Obstetricians in Turkey Related to Cord Clamping, Cord Milking, and Skin-To-Skin Contact

Objective This study was planned to evaluate obstetricians' practices of umbilical cord clamping, milking, and skin-to-skin contact applications and to determine the related variables. Material and methods A total of 522 obstetricians participated in the study. Participants were reached via the internet and a 15-item questionnaire was applied about umbilical cord clamping, cord milking, and skin-to-skin contact. Mann-Whitney U test and Student's t-test were used for continuous data and Chi-square test or Fisher's exact test for categorical data in determining the difference between groups. For the multivariate analysis, the possible factors identified with univariate analyses were entered into the logistic regression analysis to determine further independent predictors of delayed clamping. Statistical analysis was performed using the SPSS software (version 20, IBM Corp, Armonk, USA). Results It was determined that 234 (44.8%) of the participants clamped the umbilical cord early whereas 288 (55.2%) clamped it late. It was found that the delayed clamping rates of physicians working in public hospitals were significantly lower than those working in private (p<0.001). It was observed that 132 of the participants (25.3%) did not milk the cord and 180 (34.5%) of them applied it continuously, and no significant difference was found between physicians working in the public and private sectors (p=0.130). It was observed that 384 (73.6%) physicians applied skin-to-skin contact. In the multivariate regression analysis, it was determined that working status in a private hospital with a 3.6 odds ratio (OR) (95% CI = 2.0-6.3) and a low number of patients examined daily with a 1.2 OR (95%CI= 1.0-1.4) were the most important independent factors affecting the choice of delayed clamping. Conclusion It is seen that the most important parameter affecting the birth practices of physicians in our country is the employment status in public or private institutions. The age and professional experience of the physicians who clamp the umbilical cord late were found to be higher. Obstetricians are at the key point in obstetrics practice, and the experience of physicians and the type of institution they work with affect these practices.

Activation of cannabinoid 2 receptors by JWH-133 protects against ovarian ischemia-reperfusion injury in rats

We investigated the efficacy of activated cannabinoid 2 receptors for alleviating ovarian ischemia-reperfusion injury in rats. Female Wistar albino rats were divided randomly into six groups: ischemia-reperfusion (IRG); ischemia-reperfusion + 0.2 mg/kg JWH-133 (JIRG1), ischemia-reperfusion + 1 mg/kg JWH-133 (JIRG2); ischemia-reperfusion + 5 mg/kg JWH-133 (JIRG3); solvent control, and sham control. Ovarian ischemia was established for 3 h followed by reperfusion for 3 h. Ovarian tissue was investigated using histology, immunohistochemistry and biochemistry. Administration of JWH-133 synthetic cannabinoid reduced nuclear factor kappa-B immunoreactivity as well as TUNEL positivity scores and malondialdehyde levels. These reductions were significant in all cases except for the malondialdehyde levels in the 1 mg/kg JWH-133 group. Activation of cannabinoid 2 receptors by JWH-133 reduced ovarian ischemia-reperfusion injury due to its antioxidant and anti-inflammatory effects.

The Relationship Between Heavy Metal Exposure, Trace Element Level, and Monocyte to HDL Cholesterol Ratio with Gestational Diabetes Mellitus

The objective of this study is to assess the levels of heavy metals (cadmium, lead, antimony, mercury, and arsenic), which are also called endocrine-disrupting chemicals, and trace elements (chromium-III, chromium-VI, zinc, copper, and selenium) vs. monocyte to HDL ratio among pregnant women with gestational diabetes mellitus (GDM). A total of 112 pregnant women (60 with GDM and 52 healthy women) were included in this case-control study. Analysis of heavy metals and trace elements were performed in inductively coupled plasma mass spectrometer. Heavy metals (cadmium, lead, antimony, mercury, and arsenic), trace elements (chromium-III, chromium-VI, zinc, copper, and selenium), and metabolic parameters were assessed in both groups. It was determined that the levels of cadmium, lead, antimony, and copper were higher (p < 0.05) and levels of chromium-III, zinc, and selenium were lower (p < 0.05) among the GDM group compared to the control group, whereas there was a statistically insignificant difference between the two groups, regarding the levels of copper, mercury, and arsenic (p > 0.05). Moreover, the monocyte to HDL ratio was higher in the GDM group (p < 0.05), and the insulin resistance was significantly higher as well (p < 0.05). The results of our study demonstrated that environmental factors could be effective in the etiology of GDM. Toxic heavy metals, through inducing Cu, OS, and chronic inflammation, and other trace elements, either directly by impacting insulin secretion or through weakening the body's antioxidant defense system, could play a role in the occurrence of GDM.

Circulating Myonectin and Irisin Levels in Gestational Diabetes Mellitus - A Case-control Study

OBJECTIVE

The objective of this study was to assess the levels of serum myonectin and irisin in pregnant women with and without gestational diabetes mellitus (GDM).

METHOD

A total of 80 pregnant women participated in our study (which consisted of 40 patients with GDM, 40 participants as the control group). Myonectin and irisin levels were analyzed through the ELISA technique, in addition to metabolic parameters in the serum samples of the participants.

RESULTS

It was found that the levels of irisin and myonectin were lower in the GDM group compared to the control group. Moreover, it was determined that the values of age (p<0.001), body mass index (p=0.001), gravida (p=0.001), parity (p = 0.016), fasting serum glucose (p=0.001), fasting serum insulin (p=0.007), postprandial serum glucose (p=0.006), HbA1c (p<0.001), HOMA-IR (p<0.001) were higher; HDL cholesterol (p<0.001) was lower. Insulin resistance was significantly higher in the GDM group.

CONCLUSIONS

Levels of myonectin and irisin were determined to be low in the GDM group. Our results have demonstrated that myonectin and irisin could play a role in the development of GDM and that irisin as well as myonectin could be a novel biomarker for GDM.

Telomere Length in Idiopathic Recurrent Pregnancy Loss

OBJECTIVE

Telomere length is used as an indicator of biological aging. It is well known that one of the most remarkable risk factors of recurrent pregnancy losses is advanced maternal age. The objective of this study was to investigate the correlation between idiopathic recurrent pregnancy loss and telomere length.

METHOD

The study group included 40 women, while the control group consisted of 41 healthy women whose age and body mass index were matched. A venous blood sample was taken from all participants into EDTA tubes in the early follicular phase, and telomere length was measured through the qPCR technique.

RESULTS

When the mean TL of the groups was compared, it was determined that TL was significantly shorter among the iRPL group (7763.89±924.58 base pair) compared to the control group (8398.84±1102.95 base pair) (p<0.006). Whereas FSH and E2 were higher in the iRPL group, TAFC was lower (p<0.001). When the correlation between telomere length and endocrine parameters was statistically tested in the iRPL group, a negative correlation was found between FSH and telomere length (r=-0.437; p<0.001).

CONCLUSION

Shortened telomere length might play a role in the etiology of iRPL. We are of the opinion that patients with RPL should be screened for the presence of cardiovascular diseases and other chronic diseases, as is the case for POF.

Sexual function and depression in polycystic ovary syndrome: Is it associated with inflammation and neuromodulators?

Numerous studies have been carried out on depression and sexual dysfunction concomitant with polycystic ovary syndrome (PCOS). Increasing evidence has revealed the importance of inflammation in the etiology of PCOS. In addition, it has been known that some neuromodulators affect depression and sexual function. However, their effects on PCOS are not known. This study aimed to evaluate the relationship of depression and sexual function with cytokines and neuromodulators in PCOS patients. The present study included 20 fertile and 30 infertile patients diagnosed with PCOS and 30 healthy volunteers. Metabolic and endocrine parameters, interleukin (IL)-1β, IL-6, TNFα, γ-aminobutyric acid (GABA), Glutamate, Brain-derived neurotrophic factor (BDNF) serum levels, Beck Depression Index (BDI) and Female Sexual Function Index (FSFI) scores of the patients were compared between the groups. TNFα, IL-1β, IL-6, glutamate, GABA, and BDI scores were found to be significantly higher (p < 0.05) in the PCOS group (p < 0.05). Glutamate, TNFα, IL-1β, and IL-6 values were higher whereas GABA and BDNF values were lower in pateints with moderate and severe depression (p < 0.05). There were no statistically significant relationships between these parameters and the FSFI scores (p > 0.05). Multivariate logistic regression analysis was conducted with potential factors that may affect sexual dysfunction. The results indicated that high waist-to-hip ratio (WHR) (> 0.80) with an odds ratio of 1.81 in PCOS patients, and body mass index (BMI) with an odds ratio of 2.3 and high WHR (> 0.80) with an odds ratio of 1.97 in all patients were found to be independent risk factors affecting sexual dysfunction. The results of the present study suggested that chronic low-dose inflammation seen in PCOS may interact with some neuromodulators, leading to the development of depression. However, no relationship was found between these parameters and sexual function.

The Effect of Maternal Pulmonary Function Test Parameters on Umbilical Cord Blood Gas and the Duration of Labor

OBJECTIVE

To evaluate the relationship between the maternal pulmonary function test (PFT) and the Apgar score of the newborn, umbilical cord blood (UCB) gas values and the duration of delivery.

MATERIAL AND METHODS

The present study included 41 volunteer nulliparous pregnant women who presented to our obstetrics clinic and PFTs were performed by using spirometry.

RESULTS

A significant positive correlation was observed between 5^th-minute Apgar scores and maternal FEV1 (forced expiratory volume in the first second) (lt), FEV1%, FVC (lt), FVC% (r=0.509, p=0.003; r=0.47, p=0.007; r=0.434, p=0.013; r=0.417, p=0.017; respectively). A significant positive correlation was observed between UCB pH value and maternal FEV1 (lt), FVC (lt) (r=0.515, p=0.003; r=0.351, p=0.049; respectively).

CONCLUSION

Our results showed that FEV1 and FVC values, which indicate maternal respiratory functions, may affect Apgar scores of the newborn and UCB gas values.

Concordance of HPV, conventional smear, colposcopy, and conization results in cervical dysplasia

BACKGROUND

Cervical cancer screening algorithms are increasingly focused on Human Papillomavirus (HPV)-based screening while the accuracy of using abnormal cytological findings to detect dysplastic lesions still remains important. This retrospective study correlated the results of conventional cervical cytology, colposcopy guided biopsy, and cold knife conization (CKC) procedures performed in a tertiary center.

MATERIALS AND METHODS

Data from 9399 patients who underwent screening with conventional cervical cytology between 2010 and 2019 was obtained from the hospital registry. Abnormal cervical cytology and high-risk HPV DNA genotypes were recorded and their colposcopic and CKC pathology was determined.

RESULTS

Two hundred and ninety two patients underwent colposcopy for abnormal cervical cytology and/or high-risk HPV positivity. One hundred and twenty three patients were positive for High-risk HPV. Abnormal cervical cytology was detected in 216 patients. The most common cytological anomaly was atypical squamous cells of undetermined significance (ASCUS) found in 9399 patients (1.39%). It was determined that conventional cytology had a sensitivity of 70.8% and a specificity of 62.2% for the detection of low-grade lesions, while it had a sensitivity of 72.4% and a specificity of 86.0% for the detection of high-grade lesions. CKC was applied to 68 patients who were diagnosed with high-grade squamous intraepithelial lesions (HSIL) as a result of the colposcopy. As a result of CKC, a high-grade lesion was detected in 73.5% of these patients.

CONCLUSION

Conventional cervical cytology and colposcopy exhibited higher accuracy as the severity of lesions increased. Detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS.

Environmental Exposures in the Etiology of Abortion: Placental Toxic and Trace Element Levels

PURPOSE

Intensive research has been conducted on the effects of toxic and trace elements on pregnancy. Previous studies indicated a possible relationship between placental levels of these elements and first-trimester abortion; however, their effects on the further gestational weeks are not clear. This study aimed to investigate the effect of changes in the levels of placental trace and toxic elements on second-trimester abortion.

METHODS

The patient group consisted of 30 women with missed abortion. The control group comprised 60 healthy term and singleton pregnant women who gave birth. Placental samples were obtained from the patients and the healthy controls, and the concentrations of placental elements were measured using inductively coupled plasma mass spectrometry.

RESULTS

In the abortion group, placental arsenic, cadmium, mercury, lead, antimony, tin, cobalt, manganese, and selenium levels were significantly higher than those of the control group (p<0.05). Antimony was determined as an independent predictor with an odds ratio of 6.1 in toxic elements (p=0.025), and selenium was determined as an independent predictor with an odds ratio of 2.3 in trace elements (p=0.015).

CONCLUSION

The changes in trace element and toxic element levels, especially an increase in antimony and selenium, in placental tissue due to environmental exposure may play an important role in second-trimester abortion.

The relationship between oxidative stress and preeclampsia. The serum ischemia-modified albumin levels and thiol/disulfide homeostasis

Objective

Preeclampsia (PE) is a dangerous complication of pregnancy and still a major cause of maternal-fetal morbidity and mortality. Its etiology remains largely unknown, but researchers have suggested oxidative stress-mediated inflammation for the same. The purpose of this study is to investigate the relationship between oxidative stress and PE as well as the usability of oxidative stress indicators such as serum ischemia-modified albumin (IMA) levels and thiol/disulfide balance in the prediction of PE.

Materials and Methods

The study included 47 pregnant women with PE and 57 healthy pregnant women. We measured their serum IMA, native thiol, total thiol, and disulfide levels. Additionally, we determined the optimal cutoff values via the receiver operating characteristic curve analysis.

Results

There were no differences between the two groups with respect to the maternal age, body mass index, gravida, and parity. The native and total thiol levels were found to be low when the disulfide and IMA levels were high in the patients with PE (p<0.05). When the IMA level was corrected by the albumin level (IMAR), the significant difference between the two groups disappeared. We also found that the native and total thiol concentrations were correlated with the systolic and diastolic blood pressures. The optimal cut-off values calculated for the prediction of PE were as follows: 178.45 µmol/L (with sensitivity of 72% and specificity of 83%) for native thiol, 232.55 µ mol/L (with a sensitivity of 75% and specificity of 85%) for total thiol, and 29.05 µmol/L (with sensitivity of 65% and specificity of 72%) for disulfide.

Conclusion

The balance of thiol/disulfide may play a role in the pathogenesis of PE and could be used as a biological marker for PE.

Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

PURPOSE

To compare the rates obtained from hematological parameters in cases of late-onset idiopathic fetal growth restriction (FGR) with healthy pregnancies and to evaluate the effect on neonatal outcomes.

METHODS

The study group consisted of 63 pregnant women with late-onset idiopathic FGR and the control group consisted of 91 healthy pregnant women. The determined rates were calculated from the control hemograms of patients at 28 weeks. Both groups were compared for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other parameters.

RESULTS

NLR, leukocyte and neutrophil levels were significantly higher in the FGR group (p<0.05). There was no significant difference in PLR, platelet and lymphocyte levels between the groups (p>0.05). To predict FGR, the best cut-off value of NLR was determined to be 4.11 with 56% sensitivity and 88% specificity values.

CONCLUSION

Neutrophil, lymphocyte and platelet interactions have an important role in FGR development. Inflammation can be involved in the etiopathogenesis in late-onset FGR.

The effects of latency period in PPROM cases managed expectantly

Objective: Preterm premature rupture of membranes (PPROM), associated with prematurity, is an important obstetric complication that may cause neonatal mortality and morbidity. The optimal delivery time is controversial in cases with the expectant approach. The fetal effects of long-term exposure to PPROM are unknown. This study aimed to evaluate the maternal and fetal outcomes of expectantly-managed PPROM cases with different latency periods at 24^0/7-34^6/7weeks of gestation.Material and method: The study group consisted of 206 patients at 24^0/7-34^6/7weeks of gestation who met the inclusion criteria. Patients were divided into three groups according to their weeks of PPROM diagnosis as 24^0/7-28^6/7, 29^0/7-31^6/7, and 32^0/7-34^6/7. The period from membrane rupture to delivery was defined as the latency period and divided into three subgroups as 3-7 days, 8-13 days and ≥14 days. In addition to the demographic characteristics of the patients, maternal and obstetric complications, primary and secondary neonatal outcomes were compared between the groups. Primary neonatal outcomes were determined in terms of pathological Apgar scores (<5 at minute 1, <7 at minute 5), requiring resuscitation, admission to Neonatal Intensive Care Unit (NICU) and NICU length of stay. Secondary neonatal outcomes were determined in terms of respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, periventricular leukomalacia, and neonatal sepsis. In addition, for the prediction of morbidity and mortality, newborns were evaluated by SNAPPE II (Score for Neonatal Acute Physiology with Perinatal extension-II) consisting of the combination of biochemical and physiological parameters, using the parameters including mean blood pressure (mm/Hg), corporal temperature (°C), PO₂/FiO₂ ratio, lowest serum pH, multiple seizures, urine output (ml/kg/hr), Apgar score, birth weight, and small for gestational age. The higher the score of SNAPPE II, the higher the morbidity and mortality risk of neonates. For the statistical analysis, the Kruskal Wallis and one-way ANOVA tests were utilized for the numerical data. Categorical data were compared using the chi-square test. The receiver operating characteristic (ROC) test was used to determine the threshold value of the data affecting neonatal morbidity.Results: The mean PPROM week was found to be 29.7 ± 3.0 weeks and the mean delivery week was 31.8 ± 2.5 weeks. The mean latency period for all the patients was 15.1 ± 13.8 days. Clinic chorioamnionitis was observed in 17% of the cases. The lowest chorioamnionitis rate (8.6%) was in the 3-7-day latency period group. Total complications were significantly lower in the 29^0/7-31^6/7week PPROM group in which the latency period was ≥14 days, compared to those in 3-7 days and 8-13 days (p = .001). Total complications were lower in the < 32 weeks PPROM groups in which the latency period was ≥14 days compared to those obtained in 3-7 days and 8-13 days. There was no significant difference between the latency period and total complications after 32 weeks (p = .422). The best discriminative cutoff value of SNAPPE-II for neonatal morbidity was 11.0 (sensitivity 82%, specificity 80%). In the present study, the optimal latency period for the best neonatal outcomes was found to be 34.5 days (sensitivity 70% and specificity 84%) between weeks 24^0/7-28^6/7, and 11.0 days between weeks 29^0/7-31^6/7 (sensitivity 68% and specificity 85%).Conclusions: Our findings indicated that a long latency period did not increase neonatal morbidity and there was no increase in neonatal complications after 32 weeks of the gestational period compared to those obtained before 32 weeks.

An experimental study on the use of lycopene to prevent infertility due to acute oxidative ovarian damage caused by a single high dose of methotrexate

BACKGROUND

Methotrexate (MTX) is an antineoplastic agent, which increases the level of reactive oxygen species (ROS) and decreases the level of antioxidants. Lycopene, is a potent antioxidant, which is used because of its protective effect against tissue damage.

OBJECTIVES

The aim of this study was to determine the effect of lycopene on ovarian MTX-induced injury in rats.

MATERIAL AND METHODS

Rats (n = 36) were randomly divided into 3 equal groups: a group with MTX only (MG, n = 12), a group with lycopene and MTX (LMG, n = 12), and a healthy control group (HCG, n = 12). Then, malondialdehyde (MDA), myeloperoxidase (MPO) and total glutathione (tGSH) levels and histopathological findings were examined in the ovaries of rats. Apart from the histopathological and biochemical evaluation, the reproductive performance of the experimental groups was also examined.

RESULTS

Our study demonstrated that, in ovarian tissues of rats administered MTX, there was a decrease in the levels of tGSH, while MDA and MPO were increased, but it is observed that these ratios are reversed in the LMG (p < 0.05). It also has been proven that a single, high-dose use of MTX causes infertility in female rats, prolongs the gestation period and reduces the number of offspring.

CONCLUSIONS

Lycopene pretreatment ameliorates the MTX induced ovarian injury and infertility in rats through its antioxidative activities.

Awareness of women about cervical smear, human papilloma virus and human papilloma virus vaccine

Objective:

The aim of this study was to assess the awareness level of women about cervical smears, human papilloma virus (HPV), and HPV vaccine in a rural city in the central part of Anatolia.

Materials and Methods:

A total of 553 patients were included in the study. A 16 item questionnaire developed by our group was completed by all participants. The first part of the questionnaire collected the demographic and socioeconomic information of the participants. In the second part, it was questioned whether this information had a relationship with HPV, HPV vaccine awareness, and cervical screening tests. In the third part, the participants were asked questions related to the acceptance of an HPV vaccine for themselves and their willingness to give consent to have their children vaccinated.

Results:

In our study, it was found that HPV awareness significantly increased with the level of education, occupational status and total monthly family income (p<0.001). There was a significant increase in HPV vaccine awareness as the parity (p=0.016), level of education (p=0.025), and occupational status (p=0.001) increased. Having a Pap smear significantly increased with age, income, and number of parity (p<0.001).

Conclusion:

Our study revealed that only 9.8% of the women had knowledge about HPV, the majority of the women reported that they would accept vaccination for themselves and for their children. These results indicate that physicians should pay attention to increasing the awareness about HPV.

Rupture of cerebral aneurysm during pregnancy: a case report

The most common cause of subarachnoid hemorrhage at the period of pregnancy and during puerperium is rupture of an intracranial aneurysm. It is five times more common in pregnant women than in non-pregnant women. This pathology is more common in primiparous women and in the third trimester of pregnancy. A 37-year-old woman who was admitted to the emergency department with sudden-onset headache and loss of consciousness was diagnosed with intracranial hemorrhage due to middle cerebral artery aneurysm rupture. The patient, who gave birth with emergency cesarean delivery, underwent surgery for subarachnoid hemorrhage. The case is presented here because of its rarity.

Presence of sialic acid in prothoracic glands of Galleria mellonella (Lepidoptera)

The presence of sialic acid (SA) in prothoracic glands (PGs) of Galleria mellonella was determined by the methods of electron microscopy (EM), histochemistry, spectrophotometry (SP) and electronic ionization (EI)-mass spectroscopy. Histochemical observations were carried out by the cationic dye ruthenium red (RR), staining with and without neuraminidase digestion in the larval stage. Neuraminidase-sensitive SA was demonstrated by the decrease in the amount of RR-binding following neuraminidase digestion. The total amount of SA was found to be 0.09016 mg g(-1) in dry tissue by spectrophotometric determination. EI-mass spectroscopy results confirmed the EM and SP observations. The fragmentation scheme derived from EI-mass analysis exhibited the presence of the lactonized form of Neu5Gc7, 9Ac(2). On the basis of the various pieces of evidence described above, it was firmly concluded that Neu5Gc7, 9Ac(2) molecules were present in PGs of G. mellonella.

Echocardiographic study on the origin of the innocent flow murmurs

To investigate the origin of the pulmonary systolic ejection innocent flow murmur (IFM), echocardiographic examinations were undertaken in 30 children with IFM and in a control group consisting of 28 healthy children without murmur. Compared to the controls, the diameters of the left ventricular outflow tract (LVOT) and aortic valve annulus and aortic valve area tended to be smaller, whereas stroke volume (SV) and cardiac output were slightly greater in children with IFM, but they were not statistically significant. Mean fractional shortening was significantly higher in children with IFM. Peak flow velocity of LVOT, right ventricular outflow tract, aorta, and pulmonary artery, mean velocity and velocity time integral of the aortic and pulmonary flow, and maximal acceleration of the aortic flow were all significantly higher in the IFM group compared to the controls. The variables of left-sided flow velocities in the same individuals with IFM were significantly higher compared to those derived from the right heart. The ratios of the SV to the LVOT diameter and to the aortic valve area were found to be significantly greater. It was concluded that IFM originates from higher blood flow velocities in the region of LVOT and aortic valve annulus, and that the increased flow velocity results from the larger SV passing through the relatively narrow LVOT and aortic valve in children with IFM.

Catalase/superoxide dismutase (SOD) and catalase/paraoxonase (PON) ratios may implicate poor glycemic control

BACKGROUND

Previous studies suggest that elevated oxidative stress implicates poor glycemic control resulting in the development of diabetic complications. By evaluating the relationship between paraoxonase (PON) and antioxidant enzyme activities and glycemic control in diabetic patients with and without complications, we investigated whether there is a role of PON and/or antioxidant status in glycemic control.

METHODS

A total of 107 patients with type 2 diabetes mellitus (DM) was included in the study. Seventy-five patients had complications including microangiopathy, proliferative retinopathy, and/or nephropathy while 32 had no complications. The control group consisted of 29 age- and sex-matched healthy persons. Serum superoxide dismutase (SOD) and catalase activities were measured according to Sun and Goth, respectively. Basal and salt-stimulated paraoxonase activities and arylesterase activity were determined using the method of Eckerson et al.

RESULTS

There was an increase in the catalase activity and a decrease in the basal and salt-stimulated PON activity of patients when compared with controls, while no significant difference was observed in SOD activity. PON phenotypes had no effect on any parameter in patient and control groups. The ratio of catalase/SOD was 2.44 +/- 7.10 and 0.17 +/- 0.09 in diabetics and controls, respectively (p = 0.004); this was associated with an elevation in HbA1c levels. On the other hand, catalase/PON ratio was also enhanced in diabetic patients (2.8 +/- 5.2), showing a relationship with HbA1c levels compared to controls (0.29 +/- 0.3, p = 0.000).

CONCLUSIONS

The data of this study reveal that enhanced catalase/SOD and catalase /PON ratios that are correlated with HbA1c levels are observed in diabetic patients; thus, these ratios may be used as markers of poor glycemic control and as risk factors in the development of diabetic complications.

Antioxidant enzyme activities and total nitrite/nitrate levels in the collar model. Effect of nicardipine

There is a large body of literature describing the causative role of oxidative stress mediated by increased levels of reactive oxygen species in the pathogenesis of cardiovascular disease such as atherosclerosis, hypertension, and restenosis after angioplasty. The positioning of a soft silicone collar around the rabbit carotid artery elicits intimal thickening. The findings from recent studies demonstrated that both intimal thickening and atherosclerosis lead to synthesis of inducible nitric oxide synthase, resulting in abundant amounts of nitric oxide. We investigated the effects of collaring and nicardipine treatment on the activities of antioxidant enzymes, superoxide dismutase and catalase, and total nitrite/nitrate levels, stable products of nitric oxide. Placing the collar increased the total nitrite/ nitrate levels and decreased superoxide dismutase activity in collared arteries. Treatment with nicardipine (20 mg/kg/day, s.c.) prevented enhanced nitric oxide degradation without affecting superoxide dismutase and catalase activities. Our results suggest that enhanced nitric oxide production and superoxide anion are generated in response to the collaring, resulting in oxidative stress within the segment in this model.

Regression of right ventricular pressure in ventricular septal defect in infancy: a longitudinal color-flow Doppler echocardiographic study

To determine the course of right ventricular pressure (RVP) in patients with isolated ventricular septal defect (VSD) and factors influencing it, unselected 148 infants were followed-up longitudinally with color-Doppler echocardiography from a median age of 1 month for 201 patient-years. The patients were divided into three groups by absolute echographic size of VSD: group I, </=4.0 mm; group II, >4 to </=7 mm; group III, >7 mm. Sixty percent belonged to group I. Muscular defects dominated in group I, perimembranous defects dominated in group II, and those with outlet extensions dominated in group III. Peak systolic RVP was obtained by Doppler-estimated difference between systolic brachial artery and peak gradient across the VSD. Initial RVP ranged between 15 and 95 mmHg and increased in parallel to the size of defect. According to the regression equations RVP decreased in general by 0.17 mmHg per month. This correlated significantly with the size of the defect. In group I, the rate of decrease was very fast and is best expressed by a log function of time (r = -0.67, r(2) = 0.45). In groups II and III the rate of decrease was less steep and had a greater variability. RVP normalized in 100% in those of group I and in 90% of group II, at median ages of 0.17 and 0.33 years, respectively. Median Q(p):Q(s) values were 1.5, 2.2, and 3.0 in groups I-III, respectively. The outcome depended on the size of VSD. Spontaneous closure was observed in 51% of group I, 10% of group II, and none of group III. The rate was higher in muscular defects. Congestive heart failure was present in 53% and 100% in groups II and III, respectively. Death rate was 2.03%, all in patients with large defects. It is concluded that the temporal course of RVP with time can be estimated fairly well by the regression equation presented in relation to the initial size of the VSD.

The natural course of isolated ventricular septal defect during adolescence

Serial changes in patients with isolated VSD during adolescence have not previously been investigated. Hemodynamic status, diameter of the defect, and growth were studied yearly in 106 children with VSD. The mean duration of the follow-up was 13.16 years and ranged in 80% of subjects from 7 to 19 years (1395 patients years). The mean ages at pre- and postpuberty were 8.62 and 16.67, respectively. The presented longitudinal study, in which losses due to death and operation were minimal (4%), ideally reflected the natural history of VSD. Although weight showed retardation during prepuberty, this lag was caught up by the end of adolescence. Stature showed no retardation in pre- and postpuberty. Cardiothoracic ratio decreased significantly from a mean of 0.48 to 0.44 and showed normal variation. Although the mean defect diameter at prepuberty was 5.33 mm, this decreased to 2.7 postpubertally. The individual decrease (1.7 +/- 2.34 mm) was significant (t = 5.349, p < 1/10(5)). The defect closed spontaneously in 24 (22.6%). In the 75 patients without pulmonary hypertension and with mild left-to-right shunting, 52 remained in the same class and spontaneous closure was observed in 23. In the 24 patients with moderate to severe left-to-right shunt, this decreased in 23 and only one remained stable. The 2 patients (1.9%) with Eisenmenger syndrome remained stable and 1 died. Aortic regurgitation developed in 10 patients (9.4%); however, this was of mild degree in most of them. No infective endocarditis was observed. It is concluded that patients with VSD should be followed closely through adolescence, because the diameter of the defect, as well as left-to-right shunting, can decrease, and it is concluded that the spontaneous closure of the defect is to be expected in a considerable 23%, and aortic prolapse or mild regurgitation may develop in approximately 10%.

Regression of right ventricular dominance in the electrocardiogram after birth: a longitudinal follow-up of a healthy cohort from birth to 3 years

To establish the incidence and course of right ventricular (RV) conduction delay during the regression of right ventricular dominance, 12 serial ECGs were recorded at regular intervals until age 36 months in a cohort of 43 normal neonates. Additionally, ECGs were recorded similarly in 6 infants from the age of 1 month and in 7 from 2 months. The right precordial R waves were classified according to their amplitudes and their occurrence before or after the S wave. QR duration and its ratio to QRS were measured in right and left chest leads. The incidence of notched R waves, which is very rare in neonates, increased after the first month and occurred before the peak of R. Thereafter, the height of the notch decreased and then occurred after the peak of R. This turned into an r' (after the S wave) and finally the amplitude of r' decreased further and evolved into a notched S pattern. An rSR' or qRS pattern in the right precordial leads was never observed. An abnormal incomplete right bundle branch block during infancy can be distinguished from physiological right ventricular conduction delay by the unvarying amplitude of the R' wave, preceded by an S wave.

Ethanol induced oxidative stress and membrane injury in rat erythrocytes

The aim of this study was to observe membrane injury and to investigate the mechanism of antioxidant defence systems against acute ethanol toxicity. Erythrocyte superoxide dismutase and Na+, K(+)-ATPase activities were significantly decreased and catalase levels were significantly increased one hour after ethanol intoxication of male swiss albino rats. These data demonstrated that superoxide dismutase and catalase are susceptible to lipid peroxidation and that these enzymes protect tissues from free radicals. The possible mechanism involved in Na+, K(+)-ATPase and Ca(2+)-ATPase inhibition are discussed in relation to the development of ethanol toxicity and the role of lipid peroxidative processes.

Post-axial hexodactily and single atrium: a new syndrome?

A 3 1/2 year old boy is presented with postaxial hexodactily in all extremities, a persisting large left vena cava superior (VCS) draining into the left part of a single atrium and a mild dextroversio cordis. All extra fingers and the lateral parts of the fused metatarsals were amputated. At age 10, the cardiovascular anomalies were surgically corrected successfully by separating the atrium with a pericardial patch and by draining the left VCS to the right atrium with a graft. The patient seems to represent a new syndrome, since the combination of postaxial hexodactily with single atrium had previously been observed by the author in another patient in 1970.

Long-term prognosis of acute rheumatic carditis with combined aortic and mitral regurgitation

Thirty-one patients with acute rheumatic carditis associated with aortic (AR) and mitral regurgitation (MR) who received corticosteroid anti-inflammatory therapy for an average of nine weeks were followed up for 332 patient-years (mean: 10.71 years). The age of onset was 9.34 (1 SD = +/- 1.94) years. The patients were classified according to degree of left ventricular volume overloading (LVH), duration of pre-treatment interval and regularity of penicillin prophylaxis. The probability of the yearly disappearance of MR, AR and both lesions were calculated for the total group and in relation to affecting subgroups. The mean yearly rate of disappearance of AR was 2 percent after a 10 percent probability in the first year. This rate was 6.83 percent per year for MR, and it increased to 10.15 percent per year in the patients in whom therapy was initiated in less than three weeks, and decreased to 3.14 percent in the patients in whom therapy was initiated after three weeks. The disappearance of both AR and MR was observed in only two patients (about 1% per year); MS developed in two patients (6.45%) and the mortality rate was 3.2 percent in 332 patient-years (0.0001/year).

Serum and aqueous humor sialic acid levels in Behçet's disease

Serum and aqueous humor sialic acid (SA) levels were determined in 27 patients with Behçet's disease (Bd). Serum SA levels were elevated significantly during the active episode (mean, 113.4 +/- 4.12 mg/dl) and in the remission stages (mean, 85.4 +/- 4.79 mg/dl; P less than 0.001). A significant increase was also detected in active episodes when compared to chronic stages (P less than 0.02). Aqueous humor levels were also evaluated but could only be determined in the six eyes at the end-stage of the disease (mean, 2.65 +/- 0.60 mg/dl; P less than 0.05).